All Adults Pregnant Women And People With Risk Factors Should Get Tested For Hepatitis C
Most people who get infected with hepatitis C virus develop a chronic, or lifelong, infection. Left untreated, chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death. People can live without symptoms or feeling sick, so testing is the only way to know if you have hepatitis C. Getting tested is important to find out if you are infected so you can get lifesaving treatment that can cure hepatitis C.
Public Health Significance And Occurrence Of Hepatitis C
Hepatitis C occurs worldwide. Current estimates suggest that more than 250,000 Australians have been infected with this virus. An estimated 9,700 new cases of HCV occurred in 2005 however, only 354 cases were determined to be newly acquired, as most cases are subclinical, go unnoticed and are incidentally found.
Three-quarters of people infected with HCV become chronically infected with the virus. Of these, approximately 1020 per cent will develop liver cirrhosis over a period of 1540 years, and an estimated 5 per cent will develop hepatocellular carcinoma after 40 years of infection. This risk can be exacerbated by liver injury, especially concurrent alcohol use. Five per cent of infants born to HCV-infected women develop HCV infection. Breastfeeding is not an additional risk factor for transmission unless the nipples are cracked, or the baby has cuts on or inside the mouth.
There are at least six major genotypes of HCV. At present, the main genotypes found in the Australian population are 1 , 3 and 2 . It is important to determine the genotype because this guides therapy.
Awareness Prevention And Early Diagnosis Are Essential
There’s a good reason why hepatitis C is known as a “silent killer.”
According to the U.S. Centers for Disease Control and Prevention, an estimated 3.2 million Americans live with chronic hepatitis C infection, which is transmitted through infected bodily fluids like blood and semen, and causes inflammation of the liver. Yet up to 75% of people who have hepatitis C aren’t aware they have it.
Most of those living with the virus experience only mild symptoms or don’t have any symptoms at all until they develop serious liver damage or another life-threatening liver disease. Unfortunately, that means they aren’t getting diagnosed and treatment is delayed until the later stages when irreversible liver damage has occurred.
Here, hepatologistNancy Reau, MD, associate director of the Solid Organ Transplant Program at Rush University Medical Center, explains who is at risk for hepatitis C and offers advice to help you protect yourself.
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If I Get Tested For Hepatitis C And The Result Is Positive Do I Need Any Other Tests To Be Sure
When your provider wants to test you for hepatitis C, the first test you will have is the hepatitis C antibody . If this test is positive, it means you were infected with the hepatitis C virus at some point in the past. But this test alone is not enough. You will still need another test to confirm if you still have the hepatitis C virus in your system. About 1 out of 5 people who get infected with hepatitis C will be able get the rid of the virus on their own, without treatment, very early after their infection. So some people will have a positive antibody test, but a negative HCV RNA .
So, the second test that your provider should request is called hepatitis C virus RNA or HCV RNA test. There are several different tests available to check the HCV RNA. What matters is that if the RNA test is positive, then you do have chronic hepatitis C virus infection. If the RNA test is negative, then you may need to have this test again to be sure. If these RNA tests are all negative, then you no longer have hepatitis C infection and do not have chronic hepatitis C.
If your hepatitis C antibody test is positive, be sure that you get tested for hepatitis C RNA to find out whether the infection has become chronic or whether it has cleared. If the infection has become chronic, there are treatments your provider can prescribe to fight off the hepatitis C virus and keep your liver healthy.
Can I Drink Alcohol Once In A While If I Have Hepatitis C
Alcohol can clearly contribute to worsening liver disease. You must discuss with your health care provider if any amount of alcohol is safe for you.
Alcohol can cause inflammation and scarring in the liver. If you have any underlying liver condition, such as hepatitis C or hepatitis B or damage from long-term alcohol use, your liver will be more sensitive to alcohol. When you have hepatitis C virus, alcohol on top of the hepatitis C can cause the inflammation and scarring to be worse, and overall damage to the liver may happen much faster when you drink alcohol.
Here is some helpful information about alcohol and hepatitis:
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What Does It Mean When Different Types Of Blood Tests For Hepatitis C Give Different Results
The first test your provider probably will perform is called an “antibody” test. A positive result means that you were exposed to the hepatitis C virus at some point in your life.
If the result is positive, your provider will perform a second test called hepatitis C virus RNA to see if the virus is still in your body. If the RNA test result is positive, then you have chronic hepatitis C infection.
So what does it mean if you have a positive result for the first test but a negative result for the second?
How Is Autoimmune Hepatitis Diagnosed
Your healthcare provider will look at your health history and give you a physical exam.
Some lab blood tests used to diagnose autoimmune hepatitis include:
- Liver function tests. These check for inflammation or damage to your liver.
- Complete blood count or CBC. Looks at the number and types of cells in your blood.
- Coagulation panel. This test looks at how well the clotting proteins are working.
- Electrolyte panel. Checks to see if you have an electrolyte imbalance.
- Autoimmune antibodies. These are used to see if you have autoimmune hepatitis or another liver disease with similar symptoms.
- Other liver tests. These are done to check for other possible types of liver disease.
You may also have imaging tests such as:
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How To Avoid Hepatitis C
- never share any drug-injecting equipment with other people
- dont get tattoos or piercings from unlicensed places
- dont share razors, toothbrushes or towels that might be contaminated with blood or other bodily fluids
- use a condom, especially with a new partner, for anal and oral sex. You can order male and female condoms here.
How Should I Take Care Of Myself If I Have Hepatitis C
Good health habits are essential for those who have hepatitis C. You should especially avoid alcohol and medicines and drugs that can put stress on the liver. You should eat a healthy diet and start exercising regularly. Your family doctor can help you plan a diet that is healthy and practical.
Talk to your doctor about any medicines that you are taking, including over-the-counter medicine. Many medicines, including acetaminophen , are broken down by the liver. Because of this, they may increase the speed of liver damage. You should also limit alcohol use. It speeds the progression of liver diseases like hepatitis C. An occasional alcoholic drink may be okay, but check with your doctor first.
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When Should You See A Doctor Or Other Healthcare Professional
Since so many people dont experience any symptoms, healthcare professionals recommend getting screened for hepatitis C at least once in your adult life. They may recommend more frequent screenings if you have a higher risk of contracting the virus.
Hepatitis C doesnt always become severe, but the chronic form can increase your risk for liver damage, liver cancer, and liver failure.
If you have any symptoms that suggest hepatitis C, especially if theres a chance youve been exposed, connect with a doctor or another healthcare professional as soon as possible to discuss your options for testing and treatment.
With a prompt diagnosis, you can get treatment earlier, which may help prevent damage to your liver.
Who Gets Hepatitis C
Persons at highest risk for HCV infection include:
- persons who ever injected illegal drugs, including those who injected once or a few times many years ago,
- people who had blood transfusions, blood products or organ donations before June 1992, when sensitive tests for HCV were introduced for blood screening, and
- persons who received clotting factors made before 1987.
Other persons at risk for hepatitis C include:
- long-term kidney dialysis patients,
- health care workers after exposures to the blood of an infected person while on the job,
- infants born to HCV-infected mothers,
- people with high-risk sexual behavior, multiple partners and sexually transmitted diseases,
- people who snort cocaine using shared equipment, and
- people who have shared toothbrushes, razors and other personal items with a family member who is HCV-infected.
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Natural History Of Reinfection
As recorded in chimpanzees, evidence indicates that HCV RNA concentrations after reinfection in people are lower, generally more transient, and shorter in duration than during initial infection. In a longitudinal study of IDUs, median duration of HCV viraemia was four times longer during initial infection than during reinfection and peak median log HCV RNA concentration was lower , suggesting people develop adaptive protective immunity .
HCV infection, clearance, and reinfection
HCV reinfection events after spontaneous clearance have lower HCV RNA concentrations and shorter infection durations than initial HCV infection. HCV=hepatitis C virus.
However, Osburn and colleagues detected new HCV-specific T-cell responses and cross-reactive neutralising antibodies in reinfected individuals who did not clear reinfection. Therefore, although improved cellular and humoral immune responses play a part in control of reinfection, they are probably not sufficient for protection against HCV reinfection with persistence in all cases. Further longitudinal investigation of adaptive immunity during primary infection and reinfection is necessary for reliable identification of the characteristics of protective immunity associated with repeated clearance of HCV infection and hence for future vaccine research.
Preventing The Spread Of Hepatitis C
There is no vaccine available to prevent a person from being infected with hepatitis C. Recommended behaviours to prevent the spread of the virus include:
- Always use sterile injecting equipment. This can be accessed from your local needle and syringe program service.
- Avoid sharing personal items such as toothbrushes, razors, nail files or nail scissors, which can draw blood.
- If you are involved in body piercing, tattooing, electrolysis or acupuncture, always ensure that any instrument that pierces the skin is either single use or has been cleaned, disinfected and sterilised since it was last used.
- If you are a healthcare worker, follow standard precautions at all times.
- Wherever possible, wear single-use gloves if you give someone first aid or clean up blood or body fluids.
- Although hepatitis C is not generally considered to be a sexually transmissible infection in Australia, you may wish to consider safe sex practices if blood is going to be present, or if your partner has HIV infection. You may wish to further discuss this issue and personal risks with your doctor.
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Sharing Toothbrushes Scissors And Razors
There’s a potential risk that hepatitis C may be passed on through sharing items such as toothbrushes, razors and scissors, as they can become contaminated with infected blood.
Equipment used by hairdressers, such as scissors and clippers, can pose a risk if it has been contaminated with infected blood and not been sterilised or cleaned between customers. However, most salons operate to high standards, so this risk is low.
What Are The Side Effects Of Treatment
The direct acting antiviral regimens used to treat hepatitis C today are extremely well tolerated. You may experience mild side effects like headache or fatigue. For details on the side effects, review the handout specific to medication you take.
In rare instances, providers may recommend the addition of the medication ribavirin for more difficult cases of hepatitis C. Ribavirin may cause additional side effects such as fatigue, shortness of breath, cough, anemia, or rash. Patients who receive ribavirin may need more frequent monitoring for side effects as well as adjustment of the dose if side effects are experienced. For detailed information on ribavirin, patients should review the ribavirin handout.
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Prevention Of Hepatitis C
There is no vaccine for hepatitis C.
The best way to avoid getting hepatitis C is to reduce your risk factors, such as by:
- Not using intravenous drugs
- Using only sterile injection equipment if you do inject drugs, and not reusing or sharing your equipment
- Not sharing personal care items that might have blood on them, including razors, toothbrushes, and nail clippers
- Safely handling needles and other sharp equipment if you are a healthcare worker
- Not getting a tattoo, body piercing, or acupuncture treatment from an unlicensed practitioner
- Practicing safe sex
Interpreting Hcv Rna Test Results
It is essential that the provider understands how to interpret HCV RNA test results, especially during the course of HCV treatment.
|Result of HCV RNA Test||Interpretation|
|A quantified viral load — any exact number||Ongoing HCV infection|
|“Detected”||The HCV RNA is detectable but the number of international units is so low that it cannot be quantified accurately. This indicates extremely low level of virus is present.|
|“< 12 IU/mL” or “< 15 IU/mL” or “< 25 IU/mL” All of these are “less than the LLOQ”||HCV RNA is undetectable. No virus is detected at all in the patient’s serum specimen.|
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Mode Of Transmission Of Hepatitis C Virus
Hepatitis C is primarily transmitted by blood-to-blood contact. The risk of transmission is dependent on the mode and status of the source. The average risk is 1.8 per cent via a needlestick or sharps injury from an HCV RNApositive patient, and negligible if the source is HCV RNA negative.
Routes of transmission include:
- use of nonsterile injecting equipment
- needlestick injury or other parenteral inoculation this includes blood and blood product transfusions before blood-bank screening
- some household activities, such as sharing razors or toothbrushes
- invasive procedures with inadequate infection control
- vertical transmission from mother to neonate, around the time of birth .
Rates of sexual transmission of HCV infection are negligible. The risk is increased if the HCV-positive partner is immunocompromised, as the viral blood titre may be increased, or when there is the possibility of blood-to-blood contact for example, sex during menstruation and traumatic sexual practices.
A proportion of HCV-positive individuals do not fall into any known risk subgroup. They may have forgotten that they had exposure to injecting drugs many years ago or may be unwilling to discuss the possibility.
It’s Different Than Hepatitis A And B
Each form of hepatitis has its own specific virus that spreads and is treated differently. “Hepatitis simply means inflammation of the liver, or that the virus has an affinity for hurting the liver,” Reau says.
- Hepatitis A is an acute, short-term infection that often does not require treatment.
- Hepatitis B hides deep in the body and, like hepatitis C, is treated in a variety of ways, from antiviral medications to liver transplants.
“The viruses are different, but all of them should be taken very seriously since they can lead to significant liver disease and even death,” she adds.
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How Can The Spread Of Hepatitis C Be Prevented
People who have had hepatitis C should remain aware that their blood is potentially infectious.
- Do not shoot drugs if you shoot drugs, stop and get into a treatment program if you can’t stop, never share needles, syringes, water or “works”, and get vaccinated against hepatitis A and B.
- Do not share personal care items that might have blood on them .
- If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharps get vaccinated against hepatitis B.
- Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else’s blood on them or if the artist or piercer does not follow good health practices.
- HCV can be spread by sex, but this is rare. If you are having sex with more than one steady sex partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against hepatitis B.
- If you are infected with HCV, do not donate blood, organs or tissue.